A branch retinal artery occlusion (BRAO) by a septic embolus in bacterial endogenous endophthalmitis has not been previously reported. The authors present the first case of a patient with bilateral simultaneous BRAO by evident septic emboli as a complication of nephrogenic Klebsiella endophthalmitis. A 50 year-old Asian female with a history of type 2 diabetes mellitus transferred to a tertiary care facility for managing Klebsiella bacteremia with multiple abscesses in her left kidney. As she complained of painless blurred vision, ophthalmologic service was consulted. Her visual acuity was 20/32 in the right eye and 20/100 in the left eye. Slit lamp examination revealed moderate inflammations in both anterior chambers, but hypopyon was absent. Obliterative vascular changes and infiltrations surrounding with multiple retinal hemorrhages were appeared in the inferotemporal artery in her right eye. And localized severe vitritis with multiple retinal hemorrhages were observed in the superotemporal area and the posterior pole in her right eye. Prompt culture of aspirated aqueous humor along with intravitreal administration of ceftazime (2.25 mg/0.1 cc) and amikacin (0.4 mg/0.1 cc) were performed to her both eyes. Fluorescence angiogram showed an inferotemporal nonperfused are a due to BRAO in her right eye. And a round-shaped hyperfluorescent infiltration was also detected at the first bifurcation site of inferotemporal major vascular arcade, and presumed a septic embolus. In her left eye, diffuse vascular staining and blocked fluorescence by vitritis were observed. Since visual acuity and vitreal opacity of the left eye had worsened in spite of several antibiotic injections, vitrectomy was performed. Microbiologic cultures from aqueous and vitreous humor specimens were negative. After the vitrectomy, angiogram revealed superotemporal BRAO involving macular area in her left eye. And there was another hyperfluorescent lesion at the first bifurcation site of occluded major vascular arcade, analogously to her fellow eye. Her final visual acuity was 20/20 in the right eye and 20/160 in the left eye due to macular ischemia. Area of nonperfusion in both eyes were treated with scatter laser photocoagulations. While endogenous Klesiella endophthalmitis with pyogenic liver abscess has mostly been reported, ocular metastasis from renal infection has rarely been. Furthermore, this is the first case reported of infectious occlusions of bilateral branch retinal artery, which exhibited angiographically proven septic emboli in both eyes. This report suggests that the occurrence of retinal arterial occlusion should be considered in endogenous Klebsiella endophthalmitis, since this complication would affect therapeutic plans and prognostic prediction.

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